Doctor shortages, misinformation worsen care challenges in rural America: Shots

When Dr. Banu Symington first moved to Rock Springs, Wyoming, 30 years ago, she appreciated its empty desert landscapes and small-town respect for doctors like her.

Fast forward to today.

Some of Symington’s cancer patients insult him for suggesting they get vaccinated or wear masks to protect their weakened immune systems during their chemotherapy.

“I actually had a patient’s husband say to me, ‘You only want me to mask because you’re a liberal bitch.'”

Symington is among many doctors who say political attacks on science and medicine are affecting their relationships with patients, particularly in rural communities, where recruiting doctors is already a chronic challenge. Increasingly, health misinformation and conspiracy theories are filling the void created by the lack of doctors, adding challenges to care. Meanwhile, the Trump administration’s sweeping changes to health care, science, public health and immigration policies are making it more difficult to recruit foreign talent.

Conspiracy theories

In the sparsely populated mining and coal towns that dot the Rock Springs area, Symington says misinformation and political anger are endemic. For example, at a recent county fair, she stood for four hours offering free bottles of sunscreen to passersby – but found no takers. A woman asked, “Do you want to know why?” then he told Symington: “Doctors put cancer-causing chemicals in sunscreen so we’d all get cancer and they’d get rich.”

Symington says such conspiracy theories and political divisions over health and science have undermined the basic civilities that once contributed to community cohesion. “‘You’re a pharmaceutical whore,’” she told him. “They say it to my face.”

A lung cancer patient in Symington refused vaccination and then died of COVID, still angrily believing the disease was a manufactured political fiction. Symington says that until recent years, she had a friendly relationship with the man, who always offered her restaurant recommendations and suggestions for places to rock hunt, which he knew was her hobby. Her transformation is emblematic of a broader change, she says.

“It’s very difficult to help someone who looks down on your help or diminishes the value of it,” says Symington, 65 and about to retire. “Many of us who went into medicine did so because we believed we were helping people.”

There is also an increase in the use of ivermectin – an antiparasitic drug – which increases risks for patients. “I have patients who secretly take ivermectin and then end up in the intensive care unit because of an ivermectin-related complication,” Symington says. They’re doing so on advice from actor Mel Gibson, given during his January appearance on Joe Rogan’s popular conservative podcast.

Shortage of doctors

Symington is one of five full-time oncologists in Wyoming. She also runs the only radiation therapy clinic in the southwest of the state; the next closest is about three hours away, in Utah.

“When I retire, which might be sooner than expected because of the atmosphere, I don’t think they’ll be able to recruit anyone,” she says.

The doctor shortage was already acute and is contributing to shortening the lifespans of rural Americans, says Alan Morgan, CEO of the National Rural Health Association.

“There are so many workforce shortages that people can’t get past the hassle of going online to find a local doctor they can trust,” Morgan says. “The only solution to really combat this is good science, good data and making sure local clinicians are at the forefront,” disseminating accurate information.

But staffing rural health care has also become more difficult. For many decades, the United States relied heavily on foreign-born physicians; for example, half of the country’s oncology workforce comes from abroad. Today, largely because of the Trump administration’s cuts to science, medicine and research funding, as well as new immigration policies, fewer doctors can — or want to — come to the United States.

Symington says this trend is also evident in Rock Springs, which seems less hospitable even to domestic transplants like her, a white woman who was raised and educated in Philadelphia.

“Thirty years ago, many doctors emigrated from Canada,” she says. “There are no more immigrant doctors here now.”

Morgan says rural America suffers more from healthcare workforce shortages because fewer than 5 percent of doctors grew up in these communities. Morgan sees the key as fostering more local talent.

“Above all, we need to do a better job of keeping our rural kids local,” he says. “That way they know the community, the community trusts them and they can be a trusted resource.”

A bias revealed

Dr. Jennifer Bacani McKenney is the type of person Morgan is referring to. Her family practice is attached to the hospital in Fredonia, Kansas, where she was born. Her Filipino parents emigrated from the big city of Manila to this small farming community of 2,000 people in the 1970s, when her father, a surgeon, was recruited to work there. Bacani McKenney says adjusting to the community was difficult for her parents at first, but the community eventually embraced them.

“If this community hadn’t welcomed my father – or if the country hadn’t welcomed my father – I wouldn’t be here and I probably wouldn’t have the doctors I recruited here,” Bacani McKenney says.

Bacani McKenney grew up feeling treated like a hometown girl, but says the spread of COVID-19 has also exposed how some of her patients view outsiders.

“My patients were calling COVID the Chinese flu and the Kung flu – that sort of thing – and saying ‘Asians need to go home,’ and they were saying it to my face,” she recalls. “I’d say, ‘You know, I’m Asian, right?’ And they say, ‘Oh, well, we’re not talking about you.'”

Bacani McKenney is also an associate dean at the University of Kansas, where she helps place medical students in rural communities for month-long rotations as part of their program. Recently, she says more and more students — many of whom grew up in cities or are racial or sexual minorities — are opposing the requirement, complaining that they don’t feel safe in small towns. For example, patients casually make racist jokes. Navigating it, she tells them, is also part of the job.

“What we tell students is, ‘You’re going to be uncomfortable in a lot of situations in medicine.'”

But Bacani McKenney acknowledges that politics makes health care more difficult to manage these days. She changed the way she talked to patients about vaccines, for example. She suggests the familiar vaccines first, hoping to minimize growing skepticism about other vaccines, especially for preventing COVID or the flu.

“There’s something about a pneumonia shot or a tetanus shot: People say, ‘Oh yeah, I know that,'” she says.

Still, more patients are opposing his vaccine recommendations, particularly since anti-vaccine champion Robert F. Kennedy Jr. took over as Health and Human Services secretary and began amplifying views not supported by scientists and doctors. With them, she tries to maintain the conversation over several visits, if necessary. It’s the kind of balancing act her job now requires, she says.

“I think we need to keep doing it. And if people don’t like us for having this conversation, they’ll probably go somewhere else,” she says. “But if I’m not having those conversations, I’m not doing my job.”

Katie Hayes Luke edited the visuals for this story. Charles Paajoe Tetteh photography contributed.